Comparative clinical study between endovascular stent grafting on open surgery and conventional graft replacement for distal arch aneurysm

The clinical results of endovascular stent grafting (EVG) on open surgery for distal aortic arch aneurysm were compared with those of conventional graft replacement to evaluate the lesser degree of invasiveness of EVG. Thirteen men with an average age of 68 ± 6 years underwent EVG. Total arch replacement was performed in one and aortocoronary bypass grafting was combined in two. The controls were 12 men and one woman with an average age of 69 ± 5 years. Surgery were performed via midsternotomy in seven and via left thoracotomy in six. Total arch replacement was performed in five. The operation time in the EVG group was shorter than that in the control group (410 ± 88 vs. 515 ± 147 min). There were no significant differences between the groups in bypass time (228 ± 57 vs. 209 ± 39 min) and circulatory arrest time (42 ± 8 vs. 44 ± 14 min). The blood transfusion rate was 31s% in the EVG group and 77% in the control group. Long-term respiratory support was required in one EVG patient, compared with 46% of control patients. There was no operative mortality, but paraplegia occurred in one patient, cerebral infarction in one, and temporary partial spinal cord dysfunction in two in the EVG group. In the control group, one patient died of stroke, three had cerebral infarction, two had low output syndrome, one had sepsis, and one had gastrointestinal bleeding. EVG on open surgery had a shorter operative time, lower blood transfusion rate, and shorter respiratory support time. These results suggest that EVG is less invasive. However, further improvement is required to prevent complications.